Is the annual physical a waste of time? Several recent studies suggest as such. Long a rite of passage to many Americans, the annual physical may do little to prevent dying from serious illnesses and may cause unnecessary harm instead, according to a recent study. Reporting in the Cochrane Library, Danish researchers found that annual physicals do not diminish the risk of serious illnesses like cancer and heart disease.

"We did not find any signs of benefit," on death risk, researcher Lasse T. Krogsboll, a Ph.D student at the Nordic Cochrane Center in Copenhagen, Denmark, told reporters. "In the absence of documented health benefits, we would say there's a risk of overdiagnosis from this."

As health care costs continue to soar, a variety of experts have been questioning the value of common screenings once considered routine, including the annual physical. Earlier this year, the United States Preventive Service Task Force announced that yearly Pap smears, routine EKGs and prostate specific antigen blood tests (PSAs) were unnecessary, and in some cases harmful, because they lead to too many false positives.The group also rejected the annual exam as an "effective tool for improving the health of patients." In April, a group of nine physician specialty societies released a "top five" list of used tests or procedures which are probably unnecessary (see box). The list included such screening tools as a stress test and chest X-Ray, often part of a routine physical.

All that has left some doctors on the defensive, arguing that the kind of close relationship that a physical can help establish between doctor and patient can help tailor a doctor's approach to the patient, even if it doesn't necessarily lead to longer life.

"It's true that there doesn't seem to do be steady evidence that people will do better over all if they have an annual physical," Dr. Michael Elser, an internist with Alliance Medical Group in Naugatuck, says. However, Elser said, "I think it's a good thing because doctors can get to know their patients better, so when the crisis comes or you need a consultation ...it's a lot easier if I know who they are than if I only saw them 3 years ago for a cold."

At issue with the annual exam is the elimination of a long-standing health procedure and health care costs. Checkups for people with no medical condition are the single most common reason to visit a doctor, reports the Centers for Disease Control and Prevention. The cost is estimated at more than $7 billion annually. That has led many experts, like Shannon Brownlee, author of "Overtreated" to question the value of common screening tests and the annual physical. "Doctors themselves will tell you there's no point, there's no reason" for the physical, she said. "If it ain't broke, don't fix it."

Even doctors say they are pulling back on conventional wisdom that an annual physical is a good idea.

"I think there is something to be gained from seeing your doctor every year, just to touch base about health maintenance," said Dr. Lisa Sanders of Yale University, author of the New York Times popular Diagnosis column.

But besides a check of a patient's weight and blood pressure , the annual physical is "probably useless."

Dr. H. Gilbert Welch, a Professor of Medicine at the Dartmouth Institute for Health Policy & Clinical Practice, says its important to define what a physical is — and is not. He said a head-to-toe physical in which the doctor orders a series of tests to "see if we can find something wrong with you" is often fruitless.

"The problem with this approach is that we all harbor abnormalities and our diagnostic technologies are increasingly able to find them," he said via email. "This kind of check-up can literally make you sick." But a check-up that is more of a "check-in," or "an exploration, not a concerted effort to look for things that are wrong" is more valuable, he said. "This vision requires that the doctor focuses on actually talking with you — learning about what, if anything, is bothering you and what is going on with your life: your marriage, your children, your job, and your parents," he said. "This discussion — along with a few simple tests (weight, blood pressure) and a little family history gives your doctor a sense of what health risks you face."

Dr. Rebecca Andrews, an internist at the University of Connecticut Health Center, agrees. "There are a lot of people who really don't require any tests," she says. "A 40-year-old woman without a family history of breast cancer or heart disease needs very little, if any testing. But when she comes in to see you, your time is spent talking about bone health, talking about nutrition, exercise, stress management, weight control and domestic violence. It's an event that allows the relationship between a doctor and a patient to flourish."

And sometimes, those relationships bear fruit. A review of clinical studies published in 2008 found that doctors who encourage their patients to stop smoking are more likely to succeed than if the patient were to try on their own.

"The patient-physician relationship if very special," Andrews said. "Patients come in and they tell their physician things they wouldn't tell anyone else. Ads on TV don't have that same kind of effect. They know it's coming from a trusted source, not a source than has any skin in the game other than wanting to make them healthy."

Brownlee does not suggest eliminating check ups entirely. "Go to your doctor every so often to ensure that you have a relationship with a physician so that when you do get sick, this person knows who you are and knows a little bit about how you behave," she said. "These are all really good things to have. The idea that you have to go for a yearly physical to get some battery of tests, it is an enormous waste of time and money and is leading to a lot of unnecessary harm."

Moreover, sometimes what patients want out of a physical is unrealistic.

"I've had patients tell me, 'Check everything,'" Elser said. "They want to be screened to make sure they have no disease, that they're healthy.... That's nice. I wish we could do that."

Dr. Robert Carr, a Southbury internist and the medical director of the Western Connecticut Medical Group, says whether a patient needs a physical or not is often a matter of patient and physician preference. "If you're just looking at a physical as just listening to your heart and pressing on your stomach, there is not really very good evidence that there are really positive outcomes for that," he said.

But a health maintenance check, whether as a part of a doctor's visit for another complaint or a periodic check in, is critical to disease prevention, he said. "If a patient comes in for a problem and the physician notices that their blood pressure is high, most physicians are not going to not talk about that, just because (the patient) is there for ankle pain," he said. "They're going to want to follow that up."

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Top tests

In April, nine physician specialty societies collectively representing about 375,000 physicians nationwide unveiled a list of tests or procedures commonly used without good cause. They include:

n X-rays for low-back pain.

n Heart stress tests in healthy people.

n CT or MRI scans for fainting.

n CT scans for appendicitis in children.

n Dual X-ray (DEXA) screening for osteoporosis in women younger than 65 or men younger than 70.

n EKGs done routinely during a physical, even when there is no sign of heart trouble

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Travel

Tour with the Mattatuck Museum on Sunday and spend a leisurely afternoon with architectural historian Rachel Carley discovering two charming towns in the Naugatuck Valley and explore the rich history, remarkable architecture, and the unique and beautiful Matthies Park.

Outdoors

Masterpiece. Art. Perfection. Many fancy words and rapturous phrases have described Fallingwater, Frank Lloyd Wright's most famous house. It's all true. But what is also true is that I kept thinking, wow, this Mill Run, Pa., house is not childproof. A 2-year-old could tumble out that low, unlocked window and fall to his death! A toddler would drown in that unfenced plunge pool! The railings aren't high enough. The floor is too hard. And that giant open fireplace, what a safety issue. And where is the kitchen, anyway?